抗RNA聚合酶Ⅲ抗体阳性率及CD4^+、CD8^+T细胞水平检测对系统性硬化症诊断的临床研究

The clinical study of the positive rate of ARA and the level of CD4^+and CD8^+T cells in the diagnosis of SSc

目的:研究抗RNA聚合酶Ⅲ抗体(Anti-RNApolymeraseamibodies,ARA)和T淋巴细胞亚群检测对系统性硬化症(Systemicsderoderma,SSc)诊断的临床意义.方法:选择荷泽市立医院收治的SSc患者80例作为研究对象,根据患者病情是否处于活动期分为活动组40例(SSc活动期)和稳定组40例(SSc稳定期),另选择同期到菏泽市立医院进行健康体检者50例作为对照组,三组均接受自身抗体检测[采用免疫印迹法和间接免疫荧光法对ARA进行测定]和T淋巴细胞亚群检测(采用流式细胞未对外周血CD4^+T、CD8^+T细胞百分率及CD4^+T/CD8^+T比值进行检测),统计并比较三组ARA阳性率、CD4^+T细胞、CD8^+T细胞百分率及CD4^+ T/CD8^+T比值,分析ARA与SSc患者重要脏器受累的关系、ARA与SSc患者疾病进程及严重程度的关系。结果:活动组ARA阳性奉15.00%(6/40)、稳定组ARA阳性率10.00%(4/40)均高于对照组的0.00%(0/40)(P<0.05);活动组CD4^+T细胞百分率、CD8^+T/CD8^+T比值均高于稳定组和对照组,CD8^+T细胞百分率则低于稳定组和对照组(P<0.05);稳定组CD4^+T细胞百分率、CD4^+T/CD8^+T比值高于对照组,CD8^+T细胞百分率则低于对照组(P<0.05);ARA阳性者与ARA阴性者的肺间质病变情况、心脏受累情况、肾脏受累情况以及金清肌酐和尿素氮水平比较,差异均有统计学意义(P<0.05)结论:抗RNA聚合酶ID抗体以及T淋巴细胞亚群水乎检测对SSc的临床诊断均具有较高的价值,其中抗RNA聚合酶Ⅲ抗体与弥散性硬化症患者内脏受累密切相关,CD4^+T细胞、CD8^+T细胞所占比例则与SSc的临床活动度密切相关.

Objective:To study the clinical significance of combined detection of autoantibodies and T lymphocyte subsets in the diagnosis of systemic scleroderma(SSc).Methods:Eighty patients with SSc admitted to Heze Municipal Hospital from October 2018 to August 2019 were selected as the study subjects.According to whether the patients were in active stage,they were divided into active group(40 cases in active stage)and stable group(40 cases in stable stage).Another 50 patients who had health examination in Heze Municipal Hospital during the same period were selected as the control group,and three groups were selected as control group.All patients were tested for autoantibodies[anti-RNA polymerase antibodies(ARA)were detected by inimunoblotting]and T lymphocyte subsets(CD4^+T,CD8+T cell percentage and CD4^+T/CD8^+T ratio in peripheral blood were detected by flow cytometry).The positive rate of ARA,CD4^+T cells,CD8^+T cells and the ratio of CD4^+T/CD8^+T were counted and compared among the three groups.The relationship between ARA and the involvement of important organs in patients with SSc,the relationship between ARA and the progression and severity of disease in patients with SSc were analyzed.Results:The positive rate of ARA was 15.00%(6/40)in active group and 10.00%(4/40)in stable group,which were higher than 0.00%(0/40)in control group(P<0.05).The percentage of CD4^+T cells and CD4^+T/CD8^+T ratio in active group were higher than those in stable group and control group,while the percentage of CD8^+T cells was lower than that in stable group and control group(P<0.05).The percentage of CD4^+T cells and CD4^+T/CD8^+T ratio in the stable group were higher than those in the control group,while the percentage of CD8^+T cells was lower than that in the control group(P<0.05).There were significant differences in pulmonary interstitial lesions,cardiac involvcment,renal involvement and serum creatinine and urea nitrogen levels between ARA positive and ARA negative patients(P<0.05).There were significant differences in vasculitis,cardiopulmonary manifestations,skin lesions and tumors between ARA positive and ARA negative patients in recent one month(P<0.05).Conclusion:The detection of anti RNA polymerase IE antibody and T-lymphocyte subsets is ofhigh value in the clinical diagnosis of SSc.The anti RNA polymerase IE antibody is closely related to the visceral involvement of patients with diffuse sclerosis,and the proportion of CD4^+T cells and CD8^+T cells is closely related to the clinical activity of SSc.